“Black Ink” Sonographic Pattern as a Predictor for Invasive Papillary Thyroid Microcarcinoma: A Case Report

Background: This study investigated the utility of the Sonographic pattern "Black Ink" with BRAF
mutation testing of thyroid fine-needle aspiration cytology specimens for the risk papillary thyroid
microcarcinoma (PTMC).
Case Presentation: We describe a case of a 41-year-old Caucasian woman affected by a
ultrasonography “Black Ink” papillary thyroid microcarcinoma (PTMC) of the left lobe of the thyroid
gland with very tiny size (Ø 0.4 cm). The characteristics, with the Diagnostic Imaging using
Ultrasonography (US), Superb Micro-Vascular Imaging (SMI), fine-needle-aspiration cytology (FNAC)
and mutation analysis are here discussed. There are more rare subtypes of thyroid cancer as
papillary microcarcinoma "Black Ink" that even if small, are invasive and there is why the need to
early diagnosis to avoid their aggressive behavior is needed. Nowadays, focusing on the size, the
cut-off for non-occult tiny tumors has dropped to 0.3 cm. This value is of great relevance.
Conclusion: Ultrasonography, FNAC and BRAF molecular study have proven to be the most
sensitive diagnostic combination for the early detection of thyroid cancer. Despite the size of this
micro-lesion, the Black Ink ultrasonographic pattern associated with malignant cytology at FNAC
represents an important biological risk factor and could still be a predictor of the PTMC and risk for
neck lymph node metastases.